Method of patient identifier verification

ABSTRACT

A method and apparatus are provided for verification of the identity of a patient undergoing treatment administered by a medical treatment practitioner in a treatment room. An identifying element such as patient chart or patient photograph is provided for the patient which includes a patient identifier, e.g., a barcode, capable of being read by a reader device located within the treatment room. In use, the patient identifier is read by the reader device in the treatment room and a characteristic audio signal, previously assigned to the patient and known to the patient, is generated in response to the reading of the identifying element when there is a match between the patient identifier and a stored identifier for the patient. Treatment of the patient is at least temporarily withheld if any audio signal generated in response to reading of the patient identifier by the reader device is not the characteristic audio signal assigned to the patient. A special patient chart with a removable identifier can be used. A billing method which may involve the scanning step is also provided.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a Continuation of U.S. application Ser. No.10/166,167, filed on Jun. 11, 2002 now U.S. Pat. No. 6,637,649, which isa Division of U.S. application Ser. No. 09/833,785, filed on Apr. 13,2001, now U.S. Pat. No. 6,464,136, issued on Oct. 15, 2002, which is aContinuation-In-Part of application Ser. No. 09/473,138, filed on Dec.28, 1999, now U.S. Pat. No. 6,497,358, issued on Dec. 24, 2002, andwhich is based on Provisional Application Ser. No. 60/153,243, filed onSep. 13, 1999.

FIELD OF THE INVENTION

The present invention relates to record and verify systems used inmedical treatments and, more particularly, to an improved record andverification system for such use which includes a number of importantfeatures and advantages as compared with prior art systems includingthose currently in use.

BACKGROUND OF THE INVENTION

By way of background, it is instructive to briefly consider the historyof verify and record systems used in connection with radiation therapytreatment of patients using linear accelerators or other megavoltageradiation units. Verify and record systems were originally designed toverify that radiation treatments were set up correctly by the radiationtherapy technologist (RTT). This was accomplished through verificationthat certain key parameters were within predetermined tolerances. Theverify and record process has evolved more recently into an automatedset-up procedure that emphasizes rapid through-put, while de-emphasizingverification of treatment parameters that previously were set manuallyby the RTT. Some record and verify systems currently in use actuallytake control of the manual process by changing physician-selected fieldsizes, even though the field sizes fall within selected tolerancelimits. The trend toward automated systems has led to reducedinteraction between the user and the accelerator which has both positiveand negative implications. The philosophy of delivering radiationtreatment based on an automated set-up model is grounded in the desireto reduce the potential for human error in the set-up process. Thedownside of the automated or “black box” approach is the disengagementof the RTT from parameter adjustment, i.e., in relieving the RTT of thetask of setting the patient treatment parameters through adjustment ofthe linear accelerator. The negative aspect of this is that if the RTTdoes not have to set the parameters manually, the RTT is lessconditioned to perform the function manually and, therefore, lessconditioned to detect errors when these errors occur, whether theseerrors are dosimetry programming or process errors and whether theseerrors occur in manual or automated set-up modes. When the RTT isdetached from the procedure of manually setting up the patient fortreatment, it becomes more difficult for the overall treatment processto recover should the automated process fail. In this regard, when anRTT sets up a patient manually, the RTT “rehearses” the recoveryprocedure that would be used if the automated primary process shouldfail. However, when automated set-ups are employed, the RTT is less“rehearsed” in recovering efficiently when the automated process is notavailable, because such rehearsal of recovery procedures is not integralto automated treatment delivery. The more safety critical the task, themore the recovery should be rehearsed.

Given current trends in the medical industry, the trend toward automatedset-up is irreversible. Further, because of a number of factorsincluding cost pressures, the trend toward staffing reduction isirreversible, at least in the near term. It also appears clear that theelectronic record will not totally replace the paper chart, at least notin the near term. In this regard, even if it were proven better forpatient care to chart electronically, physician resistance will hinderwidespread adoption in the foreseeable future. In general, physicianswill not abandon paper charts, either from habit or for medical-legalreasons. Accordingly, the need for maintaining a paper record duringimplementation of electronic medical record keeping will continue. As aconsequence, a further vulnerability of automated radiation treatmentsystems (in addition to the disengagement of the RTT from the manualrecovery process when the automated system is temporarily down), is thepotential for mismatches between the electronic record and the papermedical record. These mismatches are commonly due to a failure of theRTT to document treatments in the paper record when the automated systemlogs the event. The problem of electronic record and paper mismatches isincreasing in the specialty of radiation oncology, as reported byclinical medical physicists.

It should be understood that disengagement of the RTT from the manualrecovery process increases risk for patient care because the verify andrecord systems, in many recent configurations, do not check for humanerror. Record and verify systems, when programmed and executedcorrectly, can prevent some errors, but not all. Record and verifysystems in current use cannot detect human errors when the system itselfis the primary process. Additionally, as indicated above, thedisengagement of the RTT from linear accelerator parameter adjustmentalso can disengage the RTT from subtle cues regarding patientidentification and radiation field placement. It would be desirable ifrecord and verify systems were configurable to allow automated set-upsat selected times for certain radiation therapy technologists and notfor others, such as, for example, when the manual skills of selectedRTTs are being assessed. However, the overall trend is clearly towardautomated set-up because of the improved throughput which results, aswell as the industry-wide momentum toward multi-leaf collimator therapy,which is more optimally performed with automation.

Greater automated throughput can lead to greater risk for other reasonsas well. Increased automation means greater potential for a mistakeoccurring through dose calculation error, with the danger of the errorbeing repeated without prompt detection once the error does occur. Theemphasis on throughput also increases the probability of errors in theactual treatment process, characterized by patient identificationerrors, field sequence errors and field alignment errors. Majorpreventable ways to harm patients through treatment process failuresinclude (1) treating the wrong patient, i.e., treating a patient with aradiation treatment intended for another patient; (2) treating the rightpatient, but on a day when the patient is not supposed to receivetreatment until other evaluations are performed first (e.g., treating apatient when the patient should have been seen by the doctor prior tothe treatment delivery), and (3) treating the right patient but with theimproper treatment set-up, i.e., treating with a wedged field without awedge, treating with the wrong monitor units (MU) programmed into theaccelerator, or treating with the wrong energy. In addition, asdescribed above, in the event that the record and verify device shouldbe temporarily unavailable due to a network, or other, problem, there isa distinct possibility or even an increased probability of parameterselection errors due to human error, because the process of automationcan change the behavior of the user, making the user more dependent onautomation. It is noted that more combination chemotherapy withradiation increases toxicity and therefore increases the potential harmthat may occur to a patient if the patient receives the wrong treatmentor if the patient is treated without proper evaluation before treatment.Moreover, pushing patients to the limit of tissue tolerance increasesthe potential for adverse events. Automated treatment may increase thepossibility of undetected mistakes related to automated set-up, therebyincreasing the possibility of patient injury.

As indicated above, the transition to automated treatment system tendsto distract the RTTs for a number of reasons. First, and very basically,the new technology creates a new process. Further, the new processdiverts RTTs from traditional cross checks in the treatment room. Thisis true of systems now in use such as the VARIS, IMPAC and LANTISsystems. In addition, visual distractions are created and the RTTs arediverted from paper chart documentation which can be critical in thesafe treatment of a patient.

Although the focus above has been on radiation therapy, it will beappreciated that similar problems exist in other medical treatmentsettings including chemotherapy as well as in neonatal care, dispensingof medications on both an inpatient and outpatient basis and in otherinpatient and outpatient applications wherein patient verification,medication verification, medication delivery device verification and thelike are of importance.

SUMMARY OF THE INVENTION

In accordance with the invention, a record and verify method is providedwhich addresses the issues discussed above. Among other advantages, themethod of the invention assists in verification of patient identity,and, according to an important feature, enlists the patient in theidentification process. The invention also documents electronically andmanually which RTT was responsible for final parameter verification,including documenting the treated patient, and time of cross-check, andthus avoiding electronic record and paper record mismatches. The patientidentification component is installed at a workstation and functionseven if the system network is down, thereby maintaining anaccountability trail as part of the recovery procedure from networkfailure.

In accordance with still another aspect of the invention, there isprovided a method of verification of an identity of a patient to which amedical treatment is to be delivered, the method comprising:

-   -   scanning a patient identifier on an item associated with the        medical treatment to be delivered to the patient and placed on        the item by a patient caregiver for the patient to which the        medical treatment is to be delivered, said patient identifier        identifying the patient to which the medical treatment is to be        delivered;    -   wherein a characteristic audio signal, previously assigned to        the patient, is generated in response to scanning of the patient        identifier; and    -   wherein the caregiver verifies the characteristic audio signal        when the characteristic audio signal is generated.

Advantageously, patient also verifies the characteristic audio signalwhen the characteristic audio signal is generated.

In an important implementation, the caregiver is a radiation therapist,the medical treatment to be delivered comprises radiation therapy, andsaid item comprises a patient treatment chart. Preferably, at least onefurther item carrying a patient identifier and associated with thedelivery of the medical treatment to be delivered is scanned.Advantageously, the first-mentioned item and the at least one furtheritem must be scanned in a predetermined sequence in order for saidcharacteristic audio signal to be generated.

In a more general implementation, the method further comprises scanninga further item carrying a patient identifier and generating saidcharacteristic audio signal in response to the scanning of said furtheritem. Preferably, both the first-mentioned item and the further itemmust be scanned in sequence in order for said characteristic audiosignal to be generated.

In another important implementation, the item comprises a medicationcontainer. Advantageously, both the medication container and a patientchart must be scanned in a predetermined sequence in order for thecharacteristic audio signal to be generated.

According to a further aspect of the invention, there is provided amethod of verification of an identity of a patient undergoing radiationtreatment administered by a radiation therapist in a treatment room, themethod comprising:

-   -   scanning a patient identifier on an item associated with the        radiation treatment to be delivered to the patient in the        treatment room, said patient identifier identifying the patient        to which the medical treatment is to be delivered;    -   generating a characteristic audio signal, previously assigned to        the patient, in response to scanning of the patient identifier;        and    -   verifying the characteristic audio signal when the        characteristic audio signal is generated.

Advantageously, the radiation therapist verifies the characteristicaudio signal when the characteristic audio signal is generated.

In one important embodiment, the item comprises a patient treatmentchart.

In an important implementation, a further item is scanned and thecharacteristic audio signal is generated only when both of said itemsare scanned. Advantageously, the characteristic audio signal isgenerated only when both of said items are scanned in predeterminedsequence.

Preferably, the scanning of the patient identifier takes place in thetreatment room.

In accordance with yet another aspect of the invention, there isprovided a method of verification of an identity of a patient to whichradiation treatment is to be delivered by a radiation treatmentcaregiver, the method comprising:

-   -   scanning a patient identifier on a patient treatment chart        associated with the radiation treatment to be delivered to the        patient, said patient identifier identifying the patient to        which the radiation treatment is to be delivered;    -   generating a characteristic audio signal, previously assigned to        the patient, in response to scanning of the patient identifier;        and    -   verifying the characteristic audio signal when the        characteristic audio signal is generated.

Preferably, the radiation treatment caregiver verifies thecharacteristic audio signal when the characteristic audio signal isgenerated.

In an advantageous embodiment, the treatment chart has a patientphotograph associated therewith.

In an important implementation, a further item is scanned and thecharacteristic audio signal is generated only when both of said itemsare scanned. Advantageously, the characteristic audio signal isgenerated only when both of said items are scanned in predeterminedsequence.

Further features and advantages of the present invention will be setforth in, or apparent from, the detailed description of preferredembodiments thereof which follows.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a block diagram of a record and verify system in accordancewith one preferred embodiment of the invention;

FIG. 2 is a flow chart of an initial consultation sequence involving thepatient to be treated; and

FIGS. 3A, 3B, 3C and 3D, taken together, are a flow chart of a recordand verify method in accordance with one preferred embodiment of theinvention;

FIG. 4 is a block diagram of a further embodiment of the verificationsystem of the invention as employed in a radiation therapy setting;

FIG. 5 is a block diagram of yet another embodiment of the verificationsystem of the invention as employed in an access control mode;

FIG. 6 is a block diagram of a still further embodiment of theverification system of the invention;

FIG. 7 is a plan view of a check sheet in accordance with a furtheraspect of the invention;

FIG. 8 is a block diagram of a treatment station in accordance with yetanother embodiment of the invention; and

FIGS. 9(a) to 9(d) are, taken together, a block form flow chart of achemotherapy treatment method in accordance with an additionalembodiment of the invention.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

Referring to FIG. 1, a block diagram is provided of one preferredembodiment of the overall system. A treatment room 10 includes aconventional linear accelerator 12 which administers the radiationtreatment to the patient and which may be any conventional analog ordigital system. Two laser verification stations 14A and 14B are providedin the treatment room 10 along with a treatment monitor 16. The stations14A and 14B are identical and each preferably includes a respectivebarcode reader 15A and 15B and a speaker 17A and 17B placed into asingle mountable box (not shown). In a preferred embodiment, theverification stations 14A and 14B are located across the treatment room10 from each other, just beyond the isocenter in the direction of themaze, with the linear accelerator 12 being located between the stations14A and 14B. Further, the stations 14A and 14B should be situated sothat a first technologist, Technologist A, is able to scan a chart oridentification card or photograph (not shown) at station 14A on the wall(the left wall is viewed in FIG. 1) while a second technologist,Technologist B, is able to scan a patient's paper verification sheet (asreferred to as an electronic sheet, or e-Sheet) at station 14B on theopposite (right) wall. As described below, the e-Sheet is a verificationsheet used by the technologist during treatment which shows scheduledand actual treatments. With this setup, each technologist faces towardsthe gantry of the accelerator 10 and the patient. It is possible to scanthe chart on the right rather than the left wall but the e Sheet wouldthen have to be scanned on the left wall scanner. It is understood thatwhile the terms “technologist” or “therapist” are used throughout, theactions described can be carried out by any qualified person includingqualified doctors, nurses and other hospital personnel and these termsare intended to cover this.

The treatment monitor 16 is used to display the name of the patient andthe treatment field values, i.e., the actual fields which are used bythe accelerator 10 and which are verified by the verification system. Atypical listing of the treatment fields is provided in Table 1 below.

TABLE 1 Treatment Chart Fields and Descriptions Number Description 1Hospital Reference Number 2 Radiation Oncology Number 3 Protocol Number4 Patient's Date of Birth 5 Referring Doctor's Name, Address, PhoneNumber and Identification number 6 Patient's Name 7 Patient's Address 8Patient's Home Phone Number 9 Patient's Work Phone Number 10 Patient'sDiagnosis 11 Diagnosis ICU-9 Code 12 Palliative or Radical 13 Definitive14 Adjuvant 15 Pre-Op 16 Post-Op 17 Chemotherapy 18 Series Number 19Current Date 20 Site to be treated 21 Field Description 22 Rx Dose 23Dose per Fraction 24 Cumulative Dose 25 Number of Fractions 26 Energy 27Modify 28 Reassess 29 Stop 30 Planned Rest 31 Total Treatments Planned32 Physician Signature 33 Previous Radiation Technologist 34 ConsentSigned 35 Collimator Size 36 SAD/SSD 37 Gantry Angle 39 Collimator Angle40 Drum/Table Angle 41 Tray/Wedge 42 Monitor Units 43 Comments 44 PortFilm Verifications 45 Inpatient/Outpatient 46 Elapsed day count fornumber of treatments (can start at 0) 47 Radiation TreatmentTechnologist 48 Monitor Units 49 Tumor Dose Cumulative dosage 50 Physics

Located outside of the treatment room in a treatment console area 18 isa verification workstation 20 including a verification monitor 22 (e.g.,a standard twenty-one inch color monitor) and an associated high-speedprinter 24 connected to the verification workstation 20. Also located inarea 18 is an accelerator workstation 26 including a card swipe reader27 and an accelerator monitor 28. The verification workstation 20basically comprises a personal computer (e.g., NT 4.0) with a keyboardand mouse, which are not illustrated, together with a barcode readerwhich is shown separately at 21 and a mounted card swipe reader shownseparately at 23. The workstation 20 preferably has a minimum of a10-Megabyte hard drive and 64 Megabytes of memory.

As indicated in FIG. 1, the system also includes a fileserver 30 for theverification workstation 20 which is normally located in a secured room32. Preferably, there is a TCP/IP connection from the verificationstation 20, and the file server 30 has enough memory to support at leastone verification workstation. The system may also include further,optional verification workstations 34 for running an administrationfunction described below.

For shorthand purposes, the method of the invention will be referred tohereinbelow as the VEEBAT (Verify Easily Electronically Before and AfterTreatment) method or process, and the verification workstation 20 willalso be referred to as the VEEBAT workstation. Moreover, certainterminology will be used which is explained below and which, for thesake of convenience, is capitalized in the description which follows andalso defined in the glossary set forth below.

Before consideration of the process in detail, it is noted that theVEEBAT process may take various paths based on its configuration. Forexample, the configuration may be set up for each patient daily, or justonce. The basic configurable parameters are Treatment Fields,technologist, patient and day of the week. Any combination of parametersmay be configured. The VEEBAT verification process may be run at theverification (VEEBAT) workstation 20 in an Auto Setup Mode or ManualSetup Mode. The mode refers to how the Treatment Field Values areentered into the accelerometer (PRIMUS) workstation 26. A Manual Setupwill have the Treatment Field Values manually entered at the acceleratorworkstation 26 and an Auto Setup will have the Field Valuesautomatically downloaded from the VEEBAT workstation 20 whichelectronically sends the treatment parameters automatically to theAccelerator workstation 26. The VEEBAT process may be configured forAuto or Manual Setup based on four parameters: the technologist, thepatient, the current day, and the treatment. The technologist parameterhas highest priority, i.e., if a particular technologist is configuredfor VEEBAT Manual only, then Manual will take precedence over Autosetup.

It is noted that the process is configured for two laser verificationstations 14A and 14B in the treatment room 10 but may be overridden tooperate with one of the laser verification stations if the other laserverification station fails.

Regarding the VEEBAT workstation 20, the process is configured with thesingle, above-mentioned barcode reader 21 located at the VEEBATworkstation 20 with the VEEBAT Verification Function. The VEEBATworkstation barcode reader 21 functions only to enable access to theapplication, not to perform the “echo function” (bar-coded photo/e-sheetcross check) described below.

The process is configured to display various reports at VEEBAT startup.The reports are as follows: partial treatment report, cumulative dosereached report, and scheduled patient report. The reports will bedisplayed on monitor 22 in a scrolling fashion that can be controlled bythe person viewing the reports. The partial treatment report will give alisting of patients who received partial treatment the previous day.This report will include the date and the patient's name. The cumulativedose reached report will list patients who have or will exceed theirprescribed cumulative dose. The patient's cumulative doses is prescribedby the Radiation Oncologist. The report will include the date and thepatient's name. The scheduled patient report will list all patients whoare scheduled for treatment on that date. The report will include thepatient's name and time of treatment.

As an initial matter, referring to FIG. 2, a Patient's File is createdon the patient's initial visit. A Patient's File creation consists ofthe initial consultation and, if advised, the patient's radiationoncology consultation. These steps are indicated in FIG. 2 by blocks 36and 38. These particular sections of the Patient's File determine if apatient should be treated and, if so, the treatment strategy. Apatient's initial consultation determines if radiation therapy isadvisable. A radiation secretary creates a Red Folder. The foldercontains the patient's referral and medical history. If treatment isadvised, a patient is set up for a radiation oncology consultation.Otherwise, the patient's Red Folder will be archived. A radiationoncology consultation determines a patient's prescribed treatment. Thepatient's initial Red Folder is then moved to a White Folder. Thepatient's VEEBAT account is created along with a Treatment Folder. TheWhite Folder is a permanent folder for a patient. It will contain theinitial Red Folder's contents and radiation oncology consultation.

After completion of a patient's scheduled treatments, all documents inthe Treatment Folder are moved to the patient's White Folder. TheTreatment Folder is used during the patient's treatments. The foldercontains a Treatment Chart, e Sheet, patient set-up photographs and thepatient's Polaroid Photo. These items are discussed below. The TreatmentFolder also contains the dose calculation work sheets and simulationdata, consent form and computer isodose plans, as well as in-vivodosimetry data. The purpose of using two folders per patient is toreduce conflicts during treatment caused by situations in whichradiation treatment technologist (R.T.T.) and nursing personnelsimultaneously require access to the medical record. The White Folderand Treatment Folder are presented to the Radiation Oncologist fortelephone calls, patient encounters, dictation, and the like. TheTreatment Chart contains a patient's original prescription and treatmentschedule signed by the Radiation Oncologist. The chart is used duringtreatment by the Technologist to manually enter Treatment Field Valuesinto the accelerator workstation 26. Typical Treatment Field Values areset forth in Table 2 below.

TABLE 2 Number Name 1 Monitor Units 2 Jaw/Collimator Size 3 CollimatorAngle 4 Gantry Angle 5 Table Drum Angle (optional)

The e Sheet is, as mentioned above, used during the verification processto store prescribed and actual Treatment field Values. A new TreatmentFolder will receive a blank e Sheet. A barcode is attached to the eSheet. A detailed listing of fields and descriptions is provided above.Each Treatment Folder contains patient's set-up photographs to indicatethe area for treatment along with tattoo markings. Each Treatment Folderalso contains a patient's Polaroid Photo. This photograph or picture isused during the verification process to help insure the Treatment Folderbelongs with the patient being treated. A barcode is attached to thePolaroid Photo.

The method and system of the invention lends itself well to accountingand billing tasks. As a first step, the patient's VEEBAT Account iscreated. The account is used in the verification procedure duringtreatments. The account is generated on a VEEBAT verificationworkstation 20 (or one of the optional workstations 34) using the VEEBATAdministration Function. A typical chart with a detailed listing offields and descriptions is provided in Table 3 below. Barcodes on thepatient's e Sheet and Polaroid photo will be associated to the patient'sVEEBAT Account. As described in more detail below, the patient will beassigned a unique audio signal (e.g., a three tone audio signal in theexemplary embodiment under consideration) that will be used for audioverification by each of the patient, Technologist A and Technologist Bin the Treatment Room prior to treatment.

TABLE 3 Patient Information RT#: Patient Name: Date of Birth: ReferringMD: (link into UPIN chart) City of Residence: Telephone No (home):Telephone No (work): Diagnosis: {ascii text} ICD 9 Code: (link into ICD9 chart) Chemotherapy y/n Hormone Therapy y/n Bar code - Polaroid photo:Bar code - e Sheet: (link to actual treatment delivered)

A simulation system provides access to a comprehensive library oftreatment strategies, including treatment protocols, simulationchecklists, guides on how to order tests, and test rationale and, asindicated by block 40 in FIG. 2, a simulation work-up can be provided aspart of the initial consultation process.

Turning now to the actual patient treatment process which is one keyaspect of the present invention, and referring to FIGS. 3A to 3D, thepatient arrives for treatment as indicated by block 42 and checks inwith the receptionist. Technologist A obtains the patient's TreatmentFolder, scans the patient's Polaroid Photo at the treatment console orworkstation 20 to initiate VEEBAT Verification Function, and ensures thepatient matches the patient Polaroid Photo, as indicated by block 44. Ifthere is a match, Technologists A and B escort the patient to treatmentroom 10 (block 46). Technologist B obtains the patient's e Sheet fromthe Treatment Folder. Technologist A scans the photo at the barcodereader 15A of the verification station 14 (block 48). If Technologist Ais unable to scan the photo for any reason, a Supervisor will berequested to help resolve the problem. Once the photo has beensuccessfully scanned, the VEEBAT verification workstation 20 willassociate the photo with the patient's VEEBAT Account in the VEEBATDatabase (block 50). If the patient's VEEBAT Account is not found, anAudio Error Signal (“beep”) will be emitted and a Supervisor will berequired to resolve the problem.

Considering in more detail the steps which take place, afterTechnologists A and B escort the patient into Treatment Room 10, thepatient is correctly positioned on treatment table. Technologist Aproceeds to either laser verification station 14A or 14B. Technologist Bproceeds to other laser verification station. It will be assumed herethat Technologist A is at station 14A and Technologist B is at station14B. Technologist A then scans barcode on the patient's Polaroid Photoat the barcode reader 15A (block 48). The barcode is passed to theVEEBAT Verification Function at the verification workstation 20 toensure the barcode matches the Polaroid Photo bar code that was justscanned outside the treatment room at the verification workstation 20.If valid, the patient's audio signal is emitted at the verificationstation 14A. If the Technologist fails to scan the Patient's PolaroidPhoto at the VEEBAT verification workstation 20, an Audio Error Signalis issued. This will require the Technologist to go back to the VEEBATverification workstation 20 to scan the Patient's Polaroid Photo barcode to initiate the VEEBAT Verification Function. Further, if the barcode scanned at barcode reader 15A of verification workstation 14A is avalid VEEBAT account bar code, but does not match the bar codepreviously scanned at the VEEBAT verification workstation 20, an audioError Signal will be emitted in this case as well and a Supervisor willbe required to resolve the problem. If the patient's e Sheet bar code isscanned first, i.e., if the bar code scanned is the e Sheet bar codeassociated with the current VEEBAT Account, an audio Warning Signal isissued and the system waits for the Patient's Polaroid Photo bar code tobe scanned. If the bar code is not a valid VEEBAT bar code, it will beconsidered to be a read error. The VEEBAT verification workstation willemit an audio Warning Signal and wait for a re-scan. Considering otherpotential failures, if the bar code is found but the patient cannot betreated, an audio Error Signal is issued. Again a Supervisor is requiredto resolve this problem. If the patient's cumulative dose exceeds orwill exceed the patient's prescribed dose, a stop order is issued. Inthis regard, the patient's VEEBAT Account has a stop treatment flag set,which is determined by the Radiation Oncologist.

The patient name and scheduled Treatment Field Values from the selectedVEEBAT Account are displayed on the treatment monitor 16 in a large fontfor easy readability. Also, if a port verification film (PVF) isscheduled, a reminder will appear on the treatment room monitor 16 toremind the technologists. Technologists A and B will visually verifythat the name displayed on the monitor matches the patient's name. Ifnot, a Supervisor shall be called to resolve the problem.

Referring to FIG. 3B, in the next step, Technologist B scans thepatient's e Sheet bar code, as indicated by block 52 at barcode reader15B of verification workstation 14B. The VEEBAT Verification Functionthen verifies that the bar code is assigned to the patient's VEEBATAccount. Verification of the patient chart and e Sheet is then provided.As shown by decision diamond 56, if valid, i.e., if there is a match,the patient's audio signal is emitted. If there is no match, an audioError Signal is emitted and a Supervisor is required to resolve thisproblem (block 58). When the tone is emitted, Technologist A,Technologist B, and the patient all verify that the audio signalsemitted from Verification Stations 14A and 14B are the same. The use ofidentification signals such as unique audio signals is an importantaspect of the invention and, among other advantages, provides a comfortlevel for the patient that is not available with other methods andsystems. If anyone questions the comparison of the audio signals, aSupervisor is required to resolve this issue. This aspect of theinvention, i.e., the use of an audio signal unique to the patient andthe requirement that the patient and the technologist (or technologists)in attendance all verify the signal, is discussed in more detail below.

Next, as shown by block 60, Technologist A proceeds to acceleratorworkstation 26 and Technologist B proceeds to the VEEBAT verificationworkstation 20 to access the VEEBAT Verification Function. TechnologistA logs onto the accelerator workstation 26 (block 62) and uses the cardswipe reader 27 located on the accelerator workstation 26 to registerwith the Verification Function of the VEEBAT verification workstation20. If Technologist A is unknown or does not have privilege to applytreatment, then the Verification Function of the verification (VEEBAT)workstation 20 will display a message at the VEEBAT workstationindicating the discrepancy. A Supervisor will be required to resolvethis problem.

Technologist B logs onto the VEEBAT verification workstation 20 by usingthe card swipe reader 23 located on the VEEBAT verification workstation20 that uses the VEEBAT Verification Function (block 64). IfTechnologist B is unknown or does not have privilege to apply treatment,then the Verification Function will display a message on the VEEBATverification workstation 20 indicating the discrepancy. A Supervisorwill be required to resolve this problem. Technologist B then views thescheduled Treatment Field Values for the patient at the VEEBATworkstation 20 (block 66).

As indicated by decision diamond 68, and was discussed above, the VEEBATprocess can be configured for Manual Setup or Auto Setup. If the formerconfirmation is chosen, as indicated by block 70, the steps set forth atthe left side of FIG. 3C are taken. Considering these steps, ManualSetup first requires that Technologist A manually enter Treatment FieldValues as indicated on the patient's Treatment Chart at the acceleratorworkstation 26. The Treatment Field Values are then automaticallyverified at the VEEBAT workstation 20 by the VEEBAT VerificationFunction against the patient's prescribed treatment. As shown by block74, Technologist A manually enters Treatment Field Values indicated onthe patient's Treatment Chart at the accelerator workstation 26.Technologist B then places the VEEBAT Verification Function inready-to-receive mode. Technologist B verbally requests Technologist Ato electronically send the patient's Treatment Field Values that weremanually entered at the accelerator workstation 26 to the VEEBATworkstation 20 (block 76). The accelerator (PRIMUS) workstation 26electronically sends the data to the VEEBAT workstation 20 whenTechnologist A presses a designated button (e.g., the “ACCEPT” button)on the accelerator keyboard (block 78). The VEEBAT workstationVerification Function will only receive values from the acceleratorworkstation 26 when the VEEBAT verification workstation is in theready-to-receive mode. At any time, Technologist B has the option tocancel the ready-to-receive mode, thus returning the VEEBAT verificationworkstation 20 to its previous state.

As indicated by block 80, the VEEBAT Verification Function, afterreceiving the accelerator values that have been entered, will thenverify all patient's Treatment Field Values and confirm that all valuesare within predetermined tolerances. If any Treatment Field Values arenot within the predetermined tolerances, the VEEBAT verificationworkstation will give an audio Warning Signal (“beep”) and display anasterisk beside each field that is not within the predeterminedtolerance. If all fields are within predetermined tolerance (i.e., whenthe output of decision diamond 82 is “yes”), the method or procedurecontinues as described below.

As indicated by decision diamond 82, if accelerator manual values areincorrect, Technologist B advises Technologist A to reenter anyTreatment Field that was flagged at the VEEBAT workstation with anasterisk (block 84). The processing is then repeated. If Technologist Aintentionally enters in a value that is not consistent with thepredetermined tolerance for any of patient's Treatment Fields, aSupervisor override is required.

Referring to the right side of FIG. 3C, the Auto Setup configurationelectronically sends values from the patient's VEEBAT Account throughthe VEEBAT verification workstation 20 to the Accelerator workstation26. In this regard, in the specific implementation under consideration,Technologist A places the accelerator workstation in a ready-to-receivemode by depressing a specific key (e.g., the F5 key) on the acceleratorkeyboard (not shown). Technologist A verbally requests Technologist B toelectronically send the patient's Treatment Field Values (block 86).Technologist B, by depressing a download key, sends the requestedpatient's Treatment Field Values to the accelerator workstation 26.

It is noted that in accordance with a further aspect of the inventiondifferent tolerances are provided for Manual Setup and Auto Setup. InAuto Setup, relatively tight tolerances are provided so that, forexample, the gantry angle tolerance may be ±1°. Although the automatedoperation has its advantages, it is important in some circumstances toprovide a manual approach wherein the RTT manually sets the TreatmentField Values. Such a manual approach can be customized to therequirements of the patient over time and, in this regard, the TreatmentField Values may be changed over the course of treatment during the day.As a consequence, the tolerances set here should be relatively wider toaccommodate the manual approach and, for example, the gantry angletolerance may set at ±5°. Thus the VEEBAT function provides a differentset of tolerances for Manual Setup versus Auto Setup.

Referring to FIG. 3D, which depicts the remainder of the method orprocedure, which is common to both the Manual Setup and Auto Setup,Technologist B requests the VEEBAT verification workstation 20 to printa treatment entry on the patient's e Sheet at printer 24 (block 86),i.e., the date, energy, MU and wedge (i.e., the number of the wedgeused, if any) for each prescribed/scheduled Treatment Field of thecurrent treatment session. This occurs before the first treatment fieldfor this treatment session. If this is not the patient's initialtreatment session, the technologist will compare the printed values onthe e Sheet to the previous treatment values (i.e. the line above on thechart). If the verification fails, a Supervisor is informed of anydiscrepancies.

As indicated by block 88, Technologist B next gives the Acceleratorworkstation 26 permission to treat the patient via the VEEBATverification workstation 20 and verbally informs Technologist A toproceed with treatment. If, during treatment, the accelerator 12 failsto give a complete treatment due to mechanical failure or technologistintervention, Technologist A may “fix” the problem and resume treatmentuntil treatment is complete. However, if Technologist A is unable tocomplete treatment due to equipment failure or human decision, aSupervisor should, at a later time but prior to next treatment, manuallywrite in the make-up dosage in the right margin of the Treatment Chartand override the patient's VEEBAT Treatment Schedule.

Next, as indicated by block 90, the actual Treatment Field Values aresent to the VEEBAT verification workstation 20 from acceleratorworkstation 26. The VEEBAT Verification Function updates the screen withactual treatment dose delivered and saves the values to the VEEBATfileserver 30. If this is not the last treatment beam of the session,the technologists return to the treatment room and set up the patientfor the next treatment field. If this is the last treatment, as shown byblock 92, Technologist B submits the e Sheet to print the actualmonitoring units (MU) on the same row of the e Sheet where theprescribed/scheduled Treatment Field Values are printed on the e Sheetin step 86 above. Thus, in a preferred embodiment, the e Sheet willinclude columns of entry spaces for the date, energy, wedge and MU, andfor initialing by the Technologist or therapist. Such an e Sheet hasimportant advantages because of its simplicity. An asterisk will beprinted beside each Treatment Field that received a MU value outside thepredetermined tolerance range. If one or more Treatment Field MUs wereprinted with asterisks, an asterisk will also be printed in the farright-hand column for the day's treatment. This asterisk indicates anydiscrepancies to the reviewing Physicist. Technologist B should initialthe e Sheet at the appropriate session entry space and hand it totechnologist A to initial and return to the patient's Treatment Folder(block 92). Technologist A enters the actual Treatment Field Values asshown on the accelerator workstation screen on the Patient's TreatmentChart (block 94). Technologist A then initials the Patient's TreatmentChart at the appropriate session line and hands it to Technologist B.Technologist B initials the Patient's Treatment Chart at the appropriatesession line and returns it to the Patient's Treatment Folder (block96).

Referring to block 98, at the end of the day, various reports can berequested. The reports are generated at a VEEBAT verificationworkstation 20 using the VEEBAT Administration Function. These reportscan include a report of patients who received partial treatment. Thisreport will list each patient that received a smaller dose for that daythan was prescribed for that day. This report shall contain patientnames and RT numbers.

The reports may also include a list of scheduled patients who were nottreated. Such a report will list each patient who was scheduled fortreatment that day but did not receive treatment that day for anyreason. This report shall also contain the Patient names and RT numbers.

Statistics can also be output for the following treatment types:electron, photon, simple, intermediate and/or complex.

A billing summary can also be produced. This report will list chargecodes for each patient treatment as well as patient's name, andconcurrent chemotherapy or hormone treatments, if any.

A report can be generated on any information maintained in the VEEBATdatabase which is located on Fileserver 30.

Considering in more detail the use of a photograph of the patient ingenerating distinctive audio output, in a preferred embodiment, aphotograph of the face of the patient with an identifying barcode istaped or otherwise affixed to the inside front jacket of the TreatmentChart, although the photograph and bar code can take other forms and beprinted or mounted on other media. When the chart photograph, withbarcode, is scanned by the barcode reader of the corresponding laserverification station in question (station 14A in the example above), asuitable audio output which is uniquely associated with, i.e., specificto, the particular patient is emitted by the speaker (not shown) of thestation. Conventional methods are available to generate a specific audiooutput in response to a corresponding triggering input, includingcomputer generation of sounds or tones. As described above, verificationstation 14B is used to scan the patient's e sheet. In the specificexemplary embodiment under consideration, the audio output is an audiosignal which takes about one second to complete. Of course, while asoothing tone sequence is preferred and has important advantages, otheraudio outputs can be used including a recording of the patient's name.

In an exemplary embodiment wherein three sequence of tones comprisingthe three tone chord is determined at simulation by the patient's RTnumber. For example, departments with different lengths of patientidentifying numbers can adjust with a different range of octaves. Fourdigit departments can use a different octave for the first digit. Fivedigit departments can use a different octave for the first and seconddigit. Digits which begin with eight or nine can use sharps or flats asthe first digit.

As indicated above, in the specific application under consideration, thesecond therapist, Therapist B, scans the patient's e Sheet at barcodereader 15B at laser verification station 14B located inside thetreatment room on the opposite wall from station 14A, and a confirmatoryaudio signal emitted from the speaker 17B at station 14B is reassuringthe staff that the Treatment Chart's face photo matches the e Sheet.This creates an opportunity to detect whether another patient's e Sheethas been inadvertently placed in the Treatment Chart. The audio signalemitted at station 14A obtained by scanning the patient's TreatmentChart should match precisely the audio signal emitted from the speaker17B at station 14B. This process of scanning the Treatment Chart,producing a patient specific audio signal and then confirming the audiosignal by scanning the e Sheet and producing the audio signal again isreferred to herein as “echoing.” Echoing is performed most efficientlywhen the e Sheet is scanned almost immediately after the Treatment Chartis scanned and thus generates its audio signal.

The sequence of Treatment Chart audio signal activation, followed by eSheet tone activation, confirms that the Treatment Chart photo barcodeis the same as the e Sheet barcode. If the wrong Treatment Chart isselected, the patient should notice a non-familiar audio signal,providing a self-managing dimension to the VEEBAT process. Patientsoften report to their radiation oncology caregivers that they count theseconds of treatment or that they occasionally report perceived changesin the sound of the accelerator as it delivers the radiation treatment.The confirmatory audio signal should reassure anxious patients, whileallowing an opportunity for wrong audio signal to be noticed by apatient. This provides an added incentive for the staff to select thecorrect Treatment Chart since the patient also participates in the crosschecking process.

In accordance with a further feature of this aspect of the invention,subsequent fields will be confirmed by a repeat of the last tone and thenext tone of the second field, the last tone and the two next tones forthe third field, and the last tone and three consecutive tones for thefourth field. Variations of this tone feedback process could be used forthree dimensional conformal therapy. Certainly, many patients arealready primed for audible feedback and the use of audio confirmationshould be of help to patients as well as the staff. The foregoingsequence of barcode scanning brings up the patient's VEEBAT parameterswhich may then be downloaded for Auto Setup or Manual Setup, followed byverification before and after treatment as described above. Thisverification process provides a number of important advantages whichwill now be described.

First, two therapists are encouraged to enter the room with the patientand the Treatment Chart, maximizing the opportunity for satisfactoryvisual crosscheck. Both therapists are encouraged to enter the roombecause efficiency inside the room will be rewarded by bringing up theVEEBAT parameters more rapidly, either for Manual Setup verification orAuto Setup. As indicated previously, two therapists are not required toenter the room but if only one therapist enters the room, she or he willstill have to bring the Treatment Chart so that no charts will be lefton the counter outside the treatment room. Moreover, the lone therapistwill still have to set up the patient properly, then activate the VEEBATqueue with the e Sheet at the right wall, i.e., at station 14B, asviewed in FIG. 1.

Further, with two therapists Therapist A must be with the patient at theleft side of Accelerator 12 before the audio signal can be generated.The Treatment Monitor 16 and the VEEBAT monitor 22 will displaysimplified patient parameters only after the e Sheet is properly scannedand the second audio signal is generated at station 14B. Typically, thesimplified parameters are defined as a field number, i.e., 1) APpelvis/prostate, 2) R lat pelvis/prostate, 3) PA pelvis/prostate, and 4)L lat. If Auto Setup has been approved by the Radiation Oncologist forthe treatment of the patient, then treatment monitor 16 (in treatmentroom 10), and VEEBAT monitor 22 (on the treatment counter) will displaythe simplified patient parameters with, e.g., red letters. If thepatient is being treated using Manual Setup, then the correspondingscreens will display the simplified patient parameters with different,e.g., white, letters.

Because the display will also appear on VEEBAT monitor 22 at thetreatment counter in area 18 which is not in treatment room 10, thisprovides advanced queuing for treatment, thereby minimizing delaysoutside the room due to delays in calling up the parameters after thepatient's alignment has been visually cross-checked.

In an advantageous implementation, patients are assigned a new RT numberand bar code for each course of radiation therapy. In an advantageousimplementation, if a patient returns to the radiation oncologydepartment in the future, e.g., for a second course of radiation therapyseveral years in the future, a fourth note will be added before thethree-tone chord assigned for the current year, creating a new four-notechord. This serves as an audible reminder to the staff that the patienthas had a previous course of therapy, and that they should watch our forpossible overlap of the current field with the prior fields. A thirdcourse of therapy will generate a fifth note. In other words, in thisimplementation, there will be two tones, followed by a pause, followedby the three-tone chord for the current course of radiation treatment.It is more difficult to audibly discriminate longer sequences of tones,and this approach takes advantage of this. The greater the number ofprior courses of radiation the patient has had in prior years, the moredifficult it is for the therapist to feel comfortable with alpha-betaconfirmations, and the more motivated he or she will be to go back tothe records to verify lack of overlap with the current fields.

One very important advantage of the verification method and system ofthe invention is that its primary method of supplemental communicationis audio, thereby eliminating the use of additional visual distractionsthat might divert the attention away of the therapists from thepatient's Treatment Chart and actual treatment setup and visualcross-check. This approach also provides for more efficient queuing ofthe server verification data to the monitor outside the treatment room,so as to provide time for therapists to perform an officialverification, followed by treatment, immediately upon reaching thetreatment counter or console. Overall, the invention should maketreatments faster and more accurate than with existing record and verifysystems, because the invention enhances and verifies efficient manualprocess without altering therapist behavior.

GLOSSARY Accelerator The actual accelerator located in the treatmentroom. Accelerator System The Accelerator Workstation and theAccelerator. Accelerator Part of the Accelerator System, Consists ofWorkstation monitor, special keyboard, and computer. Location is outsidethe room of the Accelerator. Auto Setup The Accelerator System receivesits Treatment Field Values from the Auto Download Verification FunctionBar Code A label on the Polaroid Photo and e Sheet used to identifyelectronically the patients VEEBAT Account. Card Swipe Device used toidentify user by badge number Cumulative Dose Total Radiation received eSheet Verification sheet used by Technologist during treatment showingscheduled and actual treatments Error Signal Audio tone emitted fromVEEBAT Workstation when an error requiring a Supervisor is required.ICD-9 Codes Used to categorize patients cancer location LaserVerification A verification station located in the treatment Station Aroom. Consist of a bar code reader and a speaker. Used by Technologist Ato read a patients bar coded Patients Chart. Laser Verification Averification station located in the treatment Station B room consistingof a bar code reader and a speaker. Used by Technologist A in reading apatient's bar coded Patients Chart. Manual Setup The Accelerator Systemreceives its Treatment Field Values from the Accelerator Workstation MUThe length of a treatment (Monitor Units). Patients File PatientsTreatment Chart, e Sheet, and Polaroid Photo PC Personal Computer. PVFPort Verification Film Polaroid Photo Picture of Patient RadiationOncologist Physician Red Folder A patients folder until treatment isdetermined RT Radiation Oncology Number. RTT Radiation TherapyTechnologist RTT Radiation Therapy Technologist (Technologist) SetupRoom Room where Technologist A and B run the Accelerator and VEEBATSystems Radiation Oncology Work done with the simulator to determine aConsultation patients treatment Supervisor Senior Radiation TechnologistTCP/IP Network communication protocol. Technologist A Technologistresponsible for VEEBAT Verification during treatment. Technologist BTechnologist responsible for Accelerator Workstation during treatment.Total Dose Total prescribed dose Treatment Field Actual fields used bythe Accelerator and Values verified by the Auto Download VerificationFunction. See Appendix A for list. Treatment Folder Folder used byTechnologist during treatment Treatment Monitor A monitor located in thetreatment room used to show a patients name and Treatment Field ValuesVEEBAT Account Electronic data entered via VEEBAT Workstation withVEEBAT Administration Function. VEEBAT A program running on a VEEBATWorkstation. Administration The program is used to create and accessFunction patients VEEBAT accounts stored on the VEEBAT fileserver. Theprogram also provide various report generation functions andadministrative functions (i.e. System Backup) VEEBAT Fileserver Aworkstation with houses the VEEBAT Database. VEEBAT Process VerifyEasily Electronic Before and After Treatment Process VEEBAT System Theactual components used to implement the VEEBAT Process VEEBATVerification A program running on a VEEBAT Workstation. Function Theprogram is used to provide a verification before and after treatmentVEEBAT Workstation A workstation with monitor, keyboard, mouse, CPU, barcode reader, and card swipe. The workstation provides the VEEBATAdministration and/or Verification Function. Warning Signal Audio toneemitted from VEEBAT Workstation when an error occurred but does notrequire a Supervisor. White Folder A patients permanent folder duringand after treatment

Referring to FIG. 4, a block diagram is provided of a further preferredembodiment of the overall system. The system is similar to that of FIG.1 but incorporates a number of differences as discussed hereinafter oras will become apparent. A treatment room 110 includes a conventionallinear accelerator 112 which administers the radiation treatment to thepatient and which can be any conventional analog or digital system. Asingle verification workstation is provided in the treatment room 110which is comprised of the following components which are notspecifically illustrated: a computer processor, a keyboard, and a mouse.The workstation 114 also includes a monitor 116, a single magnetic codereader 118 located at the verification workstation 114, and two sets ofbarcode readers 120A, 120B and speakers 122A, 122B. In a preferredimplementation of this embodiment, each set of barcode reader pairs120A, 120B and speaker pairs 122A, 122B are located in the treatmentroom 110 across from each other. In other words, barcode reader 120A andassociated speaker 112A are located on one side of the room and barcodereader 120B and associated speaker 122B are located on the other side ofthe room. An optional fileserver 124 is located in a remote location soas to enable the use of a client-server based system and permitting anoptional verification workstation 126 to be located in a treatmentconsole area 128 or other areas or remote rooms 130 as indicated at 132.This enables carrying out of system administration activities, initialpatient registration, and report generation but not treatmentactivities. In the treatment console area 128 are located a conventionalaccelerator workstation 134 and an associated monitor 136.

With the setup illustrated in FIG. 4, the first technologist,Technologist A, is able to swipe his or her unique ID badge at themagnetic code reader 118 located at the verification workstation 114inside the treatment room 110, registering the technologist as the“treatment” technologist. The second technologist, Technologist B, isthen able to swipe his or her unique ID badge at the magnetic codereader 118, registering the technologist as the “verification”technologist. Technologist A is then able to scan the patient photographat the barcode reader 120B located near the verification workstation114. At this time, the system will determine if the “Auto Setup”treatment described above is permitted. Access to the Auto Setupfeatures of the workstation 114 is only allowed if both technologistshave privilege for Auto Setup and if Auto Setup is approved for thetreatment of the patient. This is determined by the Radiation Oncologistand configured during initial patient registration. Next, the patient isset up at the linear accelerator 112 and oriented properly on thetreatment table. Technologist A then scans the patient photograph asecond time at the barcode reader 120B, thereby generating the patientunique audio signal. Technologist B then scans the patient's paperverification sheet (referred to above as the electronic sheet, ore-sheet or check sheet) at the opposite barcode reader 120A, therebyagain generating the patient unique audio signal.

The verification process described above in connection with FIG. 4provides a number of important advantages. First, the therapist(s) arerequired to enter the treatment room with the patient since the onlyverification workstation permitting treatment set-up, viz., verificationworkstation 114, is located inside the patient treatment room 110.Having both therapists inside the room maximizes the opportunity forsatisfactory visual crosschecks. Second, the patient's chart andphotograph must be taken into the room since these items are required togain access to the verification workstation. Together, these two itemsare the key to establishing a “default to a safe mode of operation”process or situation. In other words, with the patient's chart in thetherapist's hands and the therapist(s) inside the treatment room duringthe critical patient set-up period, the therapist(s) are given theopportunity to detect their own errors.

In another preferred embodiment, shown in FIG. 5, the system of theinvention is utilized with an existing auto-download treatment system(such as LANTIS, IMPAC, or VARIS) in a standard treatment facility. Thesystem of the present invention is indicated in FIG. 2 as the VEEBAATsystem, which as indicated above, is the trademark used to identify thesystem, and includes a computer 140, a monitor 142, a keyboard 144 and amouse 146. The conventional system includes, in the treatment room 148,a PRIMUS accelerator 150, a LANTIS auto-download unit 181 including amonitor 142, keyboard 154, mouse 156, and LANTIS KVM (keyboard, video,mouse) receiver 158. The latter is connected to a LANTIS KVM splitter160 which is located in an area 162 outside of treatment room 110 whichis, in turn, connected to a LANTIS monitor 164 and to a LANTIS computer166 connected to a PRIMUS computer 168 which controls accelerator 150.The existing auto-download treatment system communicates with theaccelerator's computer to automatically pass patient treatmentparameters prestored in a database to the accelerator 150 in the placeof requiring these treatments to be entered manually by thetechnologist.

In the configuration shown in FIG. 5, the system of the invention can beutilized to prevent access to the auto-download system unless aparticular set of criteria are met. The criteria are as follows: bothtechnologists must log into the VEEBAAT system, both technologists musthave permission to utilize the auto-download system (and as indicatedabove, this is a configurable item defined within the VEEBAAT program),the ICD-9 code (a code which defines the type/location of the cancer)must be configured to allow auto-download (also a configurable itemdefined within the VEEBAAT program), and the patient must be configuredto allow auto-download (another configurable item with the VEEBAATprogram). If any of the criteria is not met, access to the existingauto-download system is not allowed. All of the configuration items arecontrolled within the control system of the invention and can be alteredby an administrator who has been given permission to access/alter thesesettings. The system of the invention also includes a built-in accesslevel security system which enables tailoring authority or permissionsfor given users of the system. By controlling these configuration items,the treatment facility may limit the use of the auto-download system toindividual technologists, individual ICD-9 codes, individual patients,or any combination of the three, as desired.

Access to the auto-download system is controlled by an electronic KVM(Keyboard, Video, Mouse) switch 170 and controlled by computer 140. TheKVM switch 170 is located between the auto-download computer 140 and theauto-download unit 151 comprised of monitor 152, keyboard 154 and mouse156. The computer 140 of the system of the invention controls the switch170 via an RS-232 serial connection and enables/disables theauto-download system (keyboard/video/mouse) unit 151. The auto-downloadsystem is connected to Port A of the switch 170. Port B is leftunconnected. When the switch 170 is positioned to Port A, access to theauto-download system is permitted. When the switch is positioned to PortB, access to the auto-download system is prohibited.

The system of the invention allows access to the auto-download systemwhen all the required criteria have been met. If the criteria are notmet, access to the auto-download system is prevented, thereby forcingthe technologists to treat the patient in manual mode and enter thepatient treatment data manually into the computer 168 associated withthe accelerator 150. If the criteria are met, access to theauto-download system is permitted and the technologists can then loadthe patient treatment information from the database and auto-download itto the accelerator computer 168. With this configuration, theauto-download system (i.e., the monitor 152, keyboard 156, and mouse156) is located inside the treatment room alongside the VEEBAAT system(computer 140 and monitor 142, keyboard 144 and mouse 146). Thisconfiguration forces the technologists to enter the treatment room withthe patient chart. The technologists are therefore forced into a processwhich “defaults to a safe mode of operation” should a system failureoccur, since the patient chart is required to gain access into theVEEBAAT system and VEEBAAT access is required to gain access to theauto-download system.

In accordance with yet another embodiment of the invention, theinvention is used to assist verification of medications to be taken by apatient in a hospital or like patient treatment setting. In thisembodiment, a laser barcode scanner or like detector or reader, and anassociated speaker, corresponding to those described in connection withprevious embodiments, is located near or at the bedside of a patient andpreferably mounted on the wall. In addition, software is used whichgenerally corresponds to that described above but which is adapted, andsimplified, to carry the functions described.

In use of the system of this embodiment, the physician first writes anorder for medication in the patient's chart. The pharmacy within thehospital receives the order for the particular patient and dispensesmedication assigned to, i.e., in association with, a patient specificbar code assigned to that patient. In other words, the medication isdispensed in a packet, bottle, carrier, container or the like, with thepatient specific barcode thereon.

Next, the bar coded medication is picked up by or delivered to a nurseor other authorized medical practitioner who brings the medication tothe patient's beside along with the patient's medication sheet.

In the next step, the nurse scans his or her badge or activates his orher user identifier. Then the nurse provides that the medication sheetis scanned by the scanner or reader, followed by the patient'swristband, and a patient specific tone sequence is emitted based on thebarcode on the sheet. The nurse then provides scanning of the medicationcontainer or carrier (for example, an I.V. or bar-coded pill dish) so asto generate a matching tone sequence so that the nurse knows that themedication container barcode and medication sheet barcode match. Asindicated above, the patient will learn to recognize his or her patientspecific tone sequence, i.e., recognize a particular sequence as beinguniquely his or hers. Moreover, the nurse will be aware that thepatients will learn their specific tone sequence, and thus there is anincreased incentive for the nurse to verify that the medication iscorrect.

When the tone sequence is matched and identified, the patient takes thecorrect medicine. The system also records and verifies that the correctmedicine was given to the patient.

In a further implementation of this particular embodiment, the system isused to assist in identifying authorized personnel assigned to aneonatal nursery and to verify that these personnel are authorized tocare for infants, while also creating a verified data record. The onlyadditional equipment to that just described needed is a scanner unit inthe newborn nursery.

In this implementation, the identifying audio signal which is specificto the patient (again, preferably a three note chord played in sequence)is assigned to the mother in labor. When the baby is born, the baby isalso assigned a unique identifying tone sequence which is generated inresponse to scanning a barcode carried by the baby's name card on thebaby's bassinet. In the case of multiple live births, each baby receivesa unique identifying tone sequence. For example, the same chord could beused but with a different suffix or ending (e.g., chord-one, chord-two,chord-three).

The nurse must have a barcode bearing badge and when the nurse takes thenewborn from the mother, the nurse's badge is scanned by the nursethrough the barcode scanner, followed by scanning of the baby's namecard from the bassinet and next followed by scanning the baby's barcodeon a wristband or legband, and the baby's three-tone sequence isgenerated after all of these scanning operations are completed andplaying of this sequence confirms that the nurse is authorized to takethe baby to the nursery. It is noted in contrast to an alarm or thelike, the tone sequence is soothing and reassuring.

When the nurse, baby and bassinet arrive at the nursery, the nurse scansher barcode badge, followed by the bassinet barcode on the bassinet. Thecorresponding three tones, i.e., the three tone chord, will then begenerated, confirming that the assigned nurse for the infant brought theinfant into the nursery. The basic program or process verifies and thenrecords in the database the various events that occur and the time atwhich the events occurred.

When it is time for the nurse to take the baby from the nursery to themother's room, the nurse scans her bar coded badge through the scannerat the nursery, followed by the baby's name card on the bassinet. Again,the three tones are emitted, indicating that an authorized nurse istaking the infant from the nursery.

In accordance with a further embodiment of the invention, the inventionis used to assist verification of medications to be taken by a patienton an outpatient basis. In this embodiment, which is illustratedschematically in FIG. 6, a laser barcode scanner and speaker unit 180similar to those described above (or an equivalent unit,) are located inthe patient's home, indicated at H, and linked to a modem 182 to bemonitored by a home health agency or to function with a modem as a“stand-alone” in conjunction with a portable computer 184 such as apersonal data assistant (PDA) or a pocket computer. The tone recognitionsoftware generally described above would be installed on computer 184and would be programmed to recognize the barcodes on the patient'smedication bottle, packet, pill box or like container or carrier. In anadvantageous embodiment, further programming would include a medicationscheduler which would provide feedback to the patient about timing ofthe medication to be taken. For example, the program could provide foremitting the patient's identifying tone when the medication containerhas not been scanned within a predetermined period (e.g., two hours).

In operation, the process would begin with the treating physicianwriting an order for medication on the patient's prescription. Thepharmacy would receive the order for the patient and dispense themedication as assigned to a patient specific barcode on the medicationcontainer. The container with the barcode would then be given to thepatient. The patient would take the bar-coded medication container tothe scanner unit 180 and provide for scanning thereof. A tone sequenceor like audio signal, specific to the particular patient as describedabove, would be emitted thereby indicating that the medication containerhad not been scanned in the past, e.g., two hours. In an advantageousembodiment, the system would be programmed to provide specific timewindow guidance as to the taking of the medication, i.e., guidance as towhat medication was to be taken and within what time window, withtolerances being programmed in based on input from the pharmacist orhealth care provider. In any case, the program in computer 184 recordsand verifies that the medication container was scanned by the patientand records the medication and the time of day for later reporting. If,as shown in FIG. 6, the system is linked by modem 182 to a home healthagency, the report can be sent automatically to the responsible partiesvia a cordless telephone link.

It will be understood that while in the foregoing description, patientphotographs and other patient identifiers are used on the sourcedocument or card carrying the barcode that is scanned to call up thepatient record and/or the audio signal file, other identifiers, whichare individualized for a particular patient, can also be employed.Further, while including both a patient photograph and barcode on thepatient card has obvious advantages, a single patient identifier can beused, for example, to call up the audio signal file containing the audiosignal assigned to the particular patient. Other patient identifiers oridentifying processes that can be used for this purpose, and otherpurposes, include retinal scanning, fingerprint scanning, iris scanningand subcutaneously implanted microchip scanning for individuals whorequest and consent to such devices for medical care reasons. Thepatient identifier would be scanned or read by a scanner or reader,preferably located in the treatment room as previously described, so asto trigger the playing of the patient specific audio signal when apatient identification or patient match was established by the scanningoperation.

Turning to yet another aspect of the invention, although a check sheetas described above can be used in the various applications of theinvention (after suitable modification to adapt the sheet to theparticular application), in accordance with this further aspect of theinvention, an improved check sheet is provided which is shownschematically in FIG. 7 and is generally denoted 190. As shown, thecheck sheet 190 has a first barcode 192 at the top middle portion of thecheck sheet, and a second barcode 194 at the lower left portion of thecheck sheet. As discussed above, a check sheet functions in radiationtherapy as a manual quality assurance tool in real-time. In theillustrated embodiment, the barcode 192 is fixed to the top of the pageand contains the patient's radiation therapy (RT) number with a Qsuffix. In contrast, the barcode 194 is removably affixed, e.g., by anadhesive, is located at the lower left corner of the check sheet 190 andcontains the patient's RT number with a P suffix. Barcode 194 can bepeeled from the check sheet and applied to, i.e., stuck on, thepatient's identification photo, chart, identification card oridentification band at the time of simulation (e.g., virtual,fluoroscopic, clinical).

When the applied stick-on barcode 194 (photo, chart, I.D. card orpatient band) is scanned, the patient's personal audio signal file isactivated, i.e., made audible. As indicated previously, in a preferredembodiment, the audio signal is known and recognized by the patient andthe radiation therapy technologists (R.T.T.s) or other medicalpractitioner or caregiver. Scanning the fixed barcode 192 at the top ofthe check sheet 190 generates the same audio signal, confirming that thestick-on barcode 194 matches the fixed barcode 192 at the top of thecheck sheet 190. The check sheet 190 can be used in in-patientmedication delivery and infant identification such as those describedhereinabove, with I.D. bands, cards, badges and medication check sheetverification. The check sheet 190 can also be used in the outpatientmedication compliance system discussed previously.

The check sheet 190 minimizes the potential for mismatched barcodesbecause it can be assured that the patient's number is the same on bothbarcodes 192 and 194. Use of check sheet 190 is a one-step procedurewhich optimizes the probability of correctly applying the peeled barcodelabel to the correct patient record. The check sheet serves as anadditional safety net in the event other verification systems areinoperative.

The invention has principally been described above with respect to theapplication therefor to radiation therapy and although otherapplications have also been described, there are still otherapplications of importance. One of these is in the field ofchemotherapy. The system used for this application would includeanywhere from one to many individual stations. The hardware used in atypical station of such a system is shown in FIG. 8 and is comprised ofa computer 200, a touch-screen monitor 202, a keyboard 204, a mouse 206,two speakers 208 and 210, a barcode scanner 212, a laser or dot-matrixprinter 214, and a barcode printer 216. In an advantageousimplementation, all of this equipment is located on a single computerstand (not shown). The laser/dot-matrix printer 214 is used for printingof reports generated by the computer program. The barcode printer 216 isused in printing of barcode labels for new patients to be treated.

Referring to FIGS. 9(a) to 9(d), there are shown the basic steps in apreferred embodiment of the treatment verification and record method ofthis aspect of the invention. However, before considering FIGS. 9(a) to9(d), it will be understood that when a new patient is to receivechemotherapy, the process begins with assembly of a new patient chart.The steps involved are as follows:

Patient information (name, ICD-9 diagnosis, and so on, as required) isentered into the computer 200 for the new patient.

The barcode printer 216 print out two barcode labels for the patient,one for the front of the patient chart and the other to be placed on thepatient “flow sheet” (which is equivalent to the “check sheet” describedabove). This enables the system to later verify that the patient chartand the flow sheet always belong to the same patient.

The laser printer 214 prints out labels for the drug syringes used inthe chemotherapy process. A nurse indicates how many treatments areplanned for the patient and printer 214 prints out the complete set oflabels for all treatments for this patient. Pre-printed labels are thenplaced inside the patient chart. In this regard, one label is used foreach treatment session as the chemotherapy drug is prepared and placedinto the syringe for the patient. The printed label includes the patientname and, in a preferred embodiment, a barcode as well so as to allowthe system to later verify the patient chart, flow sheet, and syringesall are for the same patient just prior to treatment delivery.

Turning now to FIGS. 9(1) to 9(d), in a first step (block 220), thepatient arrives for treatment. Although the next step (block 222) mayhave been done hours earlier in the day, the patient chart is pulled andtreatment information obtained. In the next step (block 224), thesyringe filled with appropriate chemotherapy drug and the pre-printedlabel described above is placed on the syringe.

As a next step (block 226), the patient is taken to a treatment room.

In the patient room, the nurse enters treatment room with patient chart(block 228) and scans chart barcode (block 230) and flow sheet barcode(block 232). The patient specific audio signal is generated at, in thispreferred embodiment, the left speaker 208 (block 234) thereby allowingthe patient to verify that it is their chart. The system also verifieson the screen of computer 200 that the two barcodes correspond to eachother, i.e., that the patient chart and flow sheet are for same patient.The actual sequence preferably provides that the nurse select atreatment chair or regime from the touch-screen monitor 202 and indicatethat a new patient has arrived for treatment, followed by the twobarcodes being scanned and the matching audio signal being generated. Atthis point, the system would then display the patient name to the nurse,thereby providing a visual verification of the patient name.

In the next step, indicated by block 238, the patient is hooked up to anIV and some pre-treatment drugs administered. These drugs areanti-nausea, dehydration and like drugs. In one implementation of thisembodiment of the invention, these drugs are also barcoded as well andare scanned at a scanning station prior to delivery. This would aid incharge capture by providing all drugs that are delivered in connectionwith a procedure are scanned into the system.

In the next step (block 242), the pre-chemotherapy treatment isadministered. The pre-treatment drugs are normally administered forapproximately one hour. The nurse sets up a “timing bag” at the sametime, which causes an alarm to go off when pre-treatment drug deliveryis completed. To assist here, a countdown timer is advantageouslyprovided so as to enable the nurse to get an overview of each patient,their treatment status (“pre-chemo” or “chemo”), and the time remaining.After hanging the timing bag, the nurse would just select theappropriate patient chair on the touch-screen 202 and start a countdowntimer to provide an alert as well as an indication as to when thepre-treatment is completed. As indicated by block 244, the nurse wouldnormally leave the room during this period.

As set forth above, when pre-treatment is complete an alarm goes off.The nurse then retrieves patient pre-filled syringe and enters treatmentroom again with the patient chart (block 248). The patient chart, flowsheet, and syringe are scanned by scanner 212 and the patient specificaudio signal is generated in response. More specifically, as indicatedin FIG. 9(c), the barcode label on the patient chart is scanned first(block 250), the barcode label on the flow sheet is then scanned (block252), and the patient specific audio signal is generated at the leftspeaker (block 254). The barcode label on the syringe is then scanned(block 256) and a patient specific tone generated at the right speaker(block 258) thereby enabling patient verification. This also verifiesthat all barcodes are assigned to the same patient and this, of course,includes the syringes. For high-risk patients (those with specific ICD-9diagnosis or those flagged manually by the nurse during patientregistration), the system also provides a prompt for a verificationnurse to enter his or her badge or other identifier or initials at thestation to indicate that someone has verified the drugs prior toadministering the treatment. This simply adds an additional cross-checkfor high risk situations.

At this time, the nurse is able to start a countdown timer if desiredfor treatment delivery and the chemotherapy starts (step 260).

Once treatment is completed (block 262), the nurse selects a patientchair on touch-screen 202 and indicates that the treatment is completed.As indicated by block 264, the barcode labels on the patient chart andthe flow sheet are scanned by scanner 212 but no audio signal isgenerated as this is not required for this step. A report can begenerated at this time and printed in real-time to indicate the actualtreatment given as well as the previous treatment history and thetreatments remaining for the particular patient (block 266).

It will be appreciated from the foregoing that reports can be generatedfrom the computer station indicating the particular patients that havebeen treated during a given time frame. The billing secretary can usethis to verify that all patients treated for a given day were billedappropriately. In addition, in a preferred implementation, billinginformation is transferred electronically in real-time followingtreatment completion to a commercial medical billing software systemacross a network. This latter approach captures all chemotherapy chargeselectronically as they occur without requiring manual efforts alone, totrack all of the billing.

It will be appreciated that all of the steps outlined above inconnection with FIGS. 9(a) to 9(d) are not new and although a number ofadvantages of the invention should be apparent from the foregoing, it isbelieved to be helpful to contrast the treatment of FIGS. 9(a) to 9(d)with typical current treatment practice.

In a typical chemotherapy treatment, one nurse hand labels blankpeel-off labels, and a schedule and chart are used to mix the requireddrugs. After the drugs are mixed, the syringe to be used is labeled withthe patient name and the name of the drug (e.g., Adriamycin). Thelabeled syringe is placed next to the chemotherapy hood. The patient isnext escorted into the infusion area and seated in the chair. Vitalsigns are taken and they are typically recorded on a blank scrap ofpaper for later transfer to the flow sheet of the patient's chart. Thedrugs (e.g., Zofran and Decadron) are started and during this period thenurse transfers the vital signs from the scrap of paper to the flowsheet. The “timing” bag drips in so as to delay the alarm referred toabove and the infusion pump sounds the alarm when the bag runs out,indicating that it is time for the chemotherapy treatment to begin. Atthis point, the nurse hears the alarm and injects the syringe into thebag. The nurse uses then writes the drug name on the bag in “Sharpie”indelible marker, the bag is hung and the infusion rate is programmedinto the pump. After the patient receives the infusion, the nurse ornurses must document the charges manually on several forms.

In the treatment method of the invention, the patient chart is used tomix the drugs and, as indicated previously, the registration processresults in the printing of two barcodes, one for the chart and one forthe flow sheet as well as the correct number of peel-off labels for theparticular drug course or protocol. As set forth above, after the drugsare mixed, the syringe is labeled with a barcode label which includesthe patient name, the name of the drug, etc. (e.g., “Jane Smith,Adriamycin, cycle 2 of 4” or “Jane Smith, Cytoxan, cycle 2 of 4”).

The next part of the procedure is the same as in conventional treatmentthrough the seating of the patient in the treatment chair. At thispoint, the front cover of the patient chart would be scanned and theaudio signal generated in the left speaker. The chart is then opened,the flow sheet scanned and the audio signal generated in the rightspeaker. The vital signals are then taken and recorded in the chart onthe flow sheet, in real time.

As in the currently used procedure, the drugs are then started and the“timing” bag infuses to delay the alarm, the infusion pump sounds whenthe bag runs out and the nurse hears the alarm indicating that it istime for chemotherapy to start. At this point, the nurse injects thepreviously labeled syringe or syringes into the bag which is labeledwith a “Sharpie” marker as in the conventional process. At the end ofthe treatment, the nurse scans the patient chart and flow sheet and theabove-mentioned billing prompt is generated (e.g., Bill patient? (Mrs.Jane Doe) yes/no). A positive response to the billing prompt generates ahardcopy sheet which is initialed by the nurse, signifying that thesheet agrees with the flow sheet and the signed hardcopy sheet is sentto billing.

In accordance with a further aspect of the invention, a medical billingsystem and method are provided which is specifically designed to ensurecapture of charges that are sometimes missed or overlooked in billingfor medical services. The system provides for logging in of the presenceof a patient treatment chart or check sheet at a particular locationsuch as a treatment room. The presence of the chart at that location canbe determined, for example, based on an event involving the chart suchas scanning of the chart by a scanning device at that location, asdescribed above, or by using a tracking system which keeps track of thelocation of the document. When the patient treatment chart is determinedto be located in the treatment room, the presumption is that the patientis being treated and thus that services are being rendered that shouldbe billed for. By logging the presence of the chart at the treatmentroom into the billing system, the system is alerted to the fact thattreatment has occurred or will occur and that a bill for the treatmentshould be generated. If no bill is generated, the billing system isqueried as to why, and an inquiry is made.

Although the invention has been described above in connection withgenerating a characteristic audio signal in response to a match with anidentifier, and this has important specific advantages, in analternative embodiment, a visible indication or signal could be providedin a match situation, e.g., by energizing a light source. Further, aparticular visual pattern unique to the patient and known to him or hercould be generated in a match situation.

Turning to a more general consideration of the invention, it should beappreciated from the foregoing that the core method or process of theinvention is not a primary verification tool. The invention serves toprovide a secondary verification opportunity or documentationaffirmation of other verification processes and does not replace orundermine other existing verification methods. One key differencebetween the invention and other systems or methods is that the inventionenlists the patient in the identification process in a positive way. Theenlistment is done in an aesthetically pleasing manner, with theabove-described tones being emitted from the background. In this regard,it is noted that foreground stimuli would only further distract thecaregiver and/or patient who is already bombarded by stimuli fromnumerous automated systems. Further, the invention does not contributeto automation induced user complacency because the identifying toneemployed in the preferred embodiments of the invention, is a pleasingsound that differs from the beeps and alarms associated with othermedical technologies which are designed on management by exceptionstrategies. The system awards the user for doing the right thing, ratherthan penalizing the user for a misstep, which is how other systems work,and all this in view of the patient. Moreover, the tone is intended toprovide specific reassurance, not alarm, in the listener. The inventionpreferably uses a database of protected audio files that produce a tonesequence specifically assigned to the individual patient. The listenerthen recognizes his or her tone chord on a long-term basis.

As more therapies move in the direction of chronic condition managementas opposed to acute care management, the advantages of the inventionwill become even more apparent. This is particularly true in anenvironment noted for severe shortages in nursing personnel as well asin the area of high technology specialties such as radiation therapy,where new or temporary personnel are brought in to care for clients andpatients with complicated chronic medical conditions. Deliveringincorrect medication or treatments in highly specialized care settingscan have a far more serious consequence in the medical environment oftoday than it would have just a few years ago. As treatments become muchmore tailored to an individual's disease or predisposition to a disease,the consequences of delivering even one wrong treatment may be far moretoxic to the patient. Specific, targeted treatments often have anarrower therapeutic window, and may be beneficial only when deliveredto a certain patient under certain conditions. The invention is flexibleenough to be able to emit confirmatory tones under these refinedscenarios, i.e., to confirm that the patient is the correct patient, thetreatment chart is the right chart, and the sequencing or timing of thetreatment is correct, and, as indicated above, this is all done in thebackground through the use of pleasant audio signals which can berecognized internationally, independently of language differences. It isnoted that the chord sequences selected for international distributioncould be derived from major chords for individuals of western backgroundor a western country of origin, but could also be matched to the countryof origin by using in the tone assignments, minor chords or otherculturally more familiar chord-based tone sequences for individuals fromnon-western backgrounds or countries of origin. Further, a pre-chordsequence preferably provided that would serves as the geographic/year oforigination of the tone assignment.

In some of the preferred embodiments of the invention described herein,two speakers are provided in the treatment room on opposite sidesthereof. It has been found that “panning” of the audio signal across theroom, i.e., playing the sound on one side of the room in response to afirst scan and then playing the sound of the other side of the room inresponse to a second scan is advantageous. In this regard, panning helpswith recognition of the audio match event, by differentiating the eventfrom other sounds in the treatment room and by differentiating a repeatscan of the photo from scanning of the photo and then the check sheet.Preferably, the length of the tone chord is 2 to 3 seconds for amonosound setup and ½ to 2 seconds for the panning embodiments. Thesetimes are designed to provide the most efficient way to matchtask-critical entries in the shortest time and are based on maximizingdiscrimination based on tone contour and melody recognition.

It will be understood that a safety system ideally should be designed sothat a successful recovery procedure can be implemented if the primaryprocess should fail. The present invention does this because theinvention serves to provide positive confirmation. In this regard, in apreferred embodiment, if the scanned patient or treatment demographicsdo not match, resulting in no tone sequence generation, the user hearsnothing. The absence of the confirmatory tone sequence is what promptsthe caregiver or patient to question the treatment that is about to bedelivered. This is an important point because if the system of theinvention should fail for any reason, the patient or caregiver isprompted by the absence of an audio confirmation to investigate further.The system of the invention is not an alarm that prompts the user toinvestigate because if the alarm should fail, the user does not knowthat the safety mechanism has failed. If the system is silent when atone is expected, the user becomes more vigilant.

Although the invention has been described above in relation to preferredembodiments thereof, it will be understood by those skilled in the artthat variations and modifications can be effected in these preferredembodiments without departing from the scope and spirit of theinvention.

1. A method of verification of an identity of a patient to which amedical treatment is to be delivered, said method comprising: scanning apatient identifier on an item associated with the medical treatment tobe delivered to the patient and placed on the item by a patientcaregiver for the patient to which the medical treatment is to bedelivered, said patient identifier identifying the patient to which themedical treatment is to be delivered; wherein a characteristic audiosignal, previously assigned to the particular individual patient, isgenerated in response to scanning of the patient identifier; and whereinthe caregiver verifies the characteristic audio signal when thecharacteristic audio signal is generated.
 2. A method according to claim1, wherein the patient also verifies the characteristic audio signalwhen the characteristic audio signal is generated.
 3. A method accordingto claim 1 wherein the caregiver is a radiation therapist, the medicaltreatment to be delivered comprises radiation therapy, and said itemcomprises a patient treatment chart.
 4. A method according to claim 1wherein at least one further item carrying a patient identifier andassociated with the delivery of the medical treatment to be delivered isscanned.
 5. A method according to claim 4 wherein the first-mentioneditem and the at least one further item must be scanned in apredetermined sequence in order for said characteristic audio signal tobe generated.
 6. A method according to claim 1 further comprisingscanning a further item carrying a patient identifier and generatingsaid characteristic audio signal in response to the scanning of saidfurther item.
 7. A method according to claim 6 wherein both thefirst-mentioned item and the further item must be scanned in sequence inorder for said characteristic audio signal to be generated.
 8. A methodaccording to claim 1 wherein the item comprises a medication container.9. A method according to claim 8 wherein both the medication containerand a patient chart must be scanned in a predetermined sequence in orderfor said characteristic audio signal to be generated.
 10. A method ofverification of an identity of a patient undergoing radiation treatmentadministered by a radiation therapist in a treatment room, said methodcomprising: scanning a patient identifier on an item associated with theradiation treatment to be delivered to the patient in the treatmentroom, said patient identifier identifying the patient to which themedical treatment is to be delivered; generating a characteristic audiosignal, previously assigned to the particular individual patient, inresponse to scanning of the patient identifier; and verifying thecharacteristic audio signal when the characteristic audio signal isgenerated.
 11. A method according to claim 10, wherein the radiationtherapist verifies the characteristic audio signal when thecharacteristic audio signal is generated.
 12. A method according toclaim 10 wherein said scanning takes place in the treatment room.
 13. Amethod according to claim 10 wherein said item comprises a patienttreatment chart.
 14. A method according to claim 13 wherein a furtheritem is scanned and said characteristic audio signal is generated onlywhen both of said items are scanned.
 15. A method according to claim 14wherein said characteristic audio signal is generated only when both ofsaid items are scanned in predetermined sequence.
 16. A method ofverification of an identity of a patient to which radiation treatment isto be delivered by a radiation treatment caregiver, said methodcomprising: scanning a patient identifier on a patient treatment chartassociated with the radiation treatment to be delivered to the patient,said patient identifier identifying the patient to which the radiationtreatment is to be delivered; generating a characteristic audio signal,previously assigned to the particular individual patient, in response toscanning of the patient identifier; and verifying the characteristicaudio signal when the characteristic audio signal is generated.
 17. Amethod according to claim 16, wherein the radiation treatment caregiververifies the characteristic audio signal when the characteristic audiosignal is generated.
 18. A method according to claim 17 wherein thetreatment chart has a patient photograph associated therewith.
 19. Amethod according to claim 16 wherein a further item is scanned and saidcharacteristic audio signal is generated only when both of said itemsare scanned.
 20. A method according to claim 19 wherein saidcharacteristic audio signal is generated only when both of said itemsare scanned in predetermined sequence.
 21. A method of verification ofan identity of a patient to which a medical treatment is to bedelivered, said method comprising: entering a patient identifier for anitem associated with a medical treatment to be delivered to a patient tobe treated, said identifier identifying the patient to which the medicaltreatment is to be delivered; and causing reading, at a later time, ofthe patient identifier entered for the item associated with the medicaltreatment to be delivered to the patient; wherein a characteristic audiosignal, to the particular individual patient, is generated in responseto reading of the patient identifier; and wherein a caregiver verifiesthe characteristic audio signal when the characteristic audio signal isgenerated.
 22. A method according to claim 21 wherein the patient alsoverifies the characteristic audio signal when the characteristic audiosignal is generated.
 23. A method according to claim 21 wherein the itemis a patient record.
 24. A method according to claim 21 wherein thecaregiver is a radiation therapist, the medical treatment to bedelivered comprises radiation therapy, and said item comprises a patienttreatment chart.
 25. A method according to claim 21 wherein a patientidentifier is entered for at least one further item associated with thedelivery of the medical treatment to be delivered; and wherein thepatient identifier for the first-mentioned item and for at least onefurther item must be read in a predetermined sequence in order for saidcharacteristic audio signal to be generated.